A state investigation into Morton Hospital’s release of Arthur J. DaRosa, a seemingly suicidal man who went on to kill two people, found that staff who evaluated him were “thorough and comprehensive’’ and followed appropriate procedures.
A licensed social worker with more than 30 years of experience spoke with DaRosa for 2½ hours and concluded he did not need to be admitted to the hospital. A Morton emergency room physician agreed and signed off on DaRosa’s release, with recommendations for outpatient therapy, according to a state report.
When a supervisor called the social worker to tell her about the tragic events that unfolded after DaRosa’s release, the social worker, who was not named, told state investigators she was “incredulous and shocked’’ and unable to speak.
“Based on the multiagency review, there is no evidence to suggest that inappropriate care was provided during the patient’s encounter at Morton Hospital,’’ according to the report, from the Executive Office of Health and Human Services.
As part of a broader examination of patient records, it did find general problems with how the Taunton hospital cared for psychiatric patients in the emergency department, including failing to properly supervise social workers and missing and inaccurate information in patient medical records.
The report did not identify DaRosa, 28, by name, but the dates and circumstances matched the tragic details of his case.
The events unfolded when DaRosa was brought by ambulance to the emergency room on the evening of Monday, May 9. Relatives said he was threatening to kill himself and had told them the devil was playing tricks on him and trying to poison his children.
While an investigative report by one of the agencies involved in the review, the Department of Mental Health, is heavily redacted, the social worker spoke to him about parenting strategies and other problems in his life, and said he was receptive.
The hospital released him hours later, at about 4 a.m. Tuesday.
Later that day, the authorities said, DaRosa went on a rampage, fatally stabbing an 80-year-old woman in her Taunton home and a 56-year-old man dining with his wife at a Bertucci’s restaurant in a mall 4 miles away. DaRosa, who also injured five others, was shot and killed by an off-duty sheriff’s deputy who had been eating dinner at Bertucci’s.
The tragedy unleashed bitter feelings at some hospitals over a system that requires hospitals to use independent social workers, instead of their own doctors and nurses, to evaluate Medicaid patients who are seeking mental health treatment. The evaluations for Medicaid mental health patients at Morton are conducted by Norton Emergency Services, which is run by the state Department of Mental Health, said Health and Human Services spokeswoman Sharon Torgerson.
Two days after the shootings, Morton pulled out of that system, meaning that the hospital might not be reimbursed for psychiatric care given to Medicaid patients since.
Another investigative report from the Department of Public Health said Morton did not “credential’’ social workers employed by the outside vendor, evaluate their performance, enroll them in quality improvement programs, or assign them to specific hospital managers.
The inspectors also said that out of 21 patient medical records reviewed, 20 were incomplete or contained inaccuracies. The record of one patient — referred to only as “patient #1” — did not contain a proper “discharge recommendation form.’’ A portion of the discharge instructions in the record were for another patient.
The head of emergency medicine told state investigators that a physician saved a template with another patient’s information on the computer and later used this template for patient #1.
The agency spent eight days at the hospital in May, after which the federal Centers for Medicare & Medicaid Services threatened to terminate the hospital as a Medicare provider if it did not correct the problems. Health and Human Services officials said the hospital made improvements, and the federal agency withdrew its threat based on another visit July 6.
In the report, the hospital blamed the state-controlled vendor for the problems in the emergency department. Hospital executives said they repeatedly asked the vendor to allow them to see social worker files so they could determine if they had enough experience and education to be credentialed by the hospital. The vendor refused, they said.
Executives said they wanted to get rid of the vendor for years, but were told that it was the only option for evaluating Medicaid patients in the emergency room — if the hospital wanted to be paid for providing care to them.
“We are working collaboratively with the state to change their policy, and they have agreed to have only licensed and credentialed evaluators see behavioral health patients at Morton,’’ said Jeff Hall, a spokesman for Steward Health Care System, which owns Morton.
Torgerson said that “behavioral health clinicians who work for emergency services programs across the state are highly qualified and trained specialists.’’
As a result of the multiagency review, the state is reviewing all agreements in place between its mental health vendors and hospital emergency departments to ensure they conform to hospital policies about credentialing medical staff, the state said.